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HealthPlan Payer/Provider Senior Specialist

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Date: Jan 2, 2022

Location: Boston, MA, US

Company: NTT DATA Services

Req ID: 126443 

NTT DATA Services strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.

We are currently seeking a HealthPlan Payer/Provider Senior Specialist to join our team in Boston, Massachusetts (US-MA), United States (US). (Remote workers accepted)

Position Responsibilities:

  • Coordinate day to day testing efforts within the project
  • Be the primary QA contact for the Project Management team
  • Provide status reports for the PM and QA management team
  • Work with testers to provide estimates
  • Develop and /or maintain Test Strategy including scope, testing schedule, Risks, and issues
  • Identify and remove barriers preventing testing activities
  • Manage the training of testers to support the Project
  • Coordinate defect training and review meetings
  • Escalate issues to test Management
  • First point of contact for any QA project-related questions or issues

 

Position Requirements:

 

  • 3+ years experience with Medicare Advantage and Managed Medicaid
  • 3+ years of experience in Provider Relations with a Health Plan
  • 3+ years knowledge of claim processing and guidelines
  • Experience in customer service, claims processing, claims auditing, provider contracting and provider relations is desirable
  • Knowledge/familiarity with medical terminology (CPT, HCPC, ICD10)
  • Basic medical knowledge – medical terms and common medical procedures
  • Understanding of insurance practices – procedures that govern payouts and claim denials
  • Knowledge/familiarity of various pricing methodologies  (fee for service, capitation, DRG)
  • Knowledge of provider demographics/credentials (NPI, TIN#, Medicare CMS cert #, taxonomy classifications, degrees)
  • Ability to analyze root cause issues, problem solve, and provide recommendations for process improvements.
  • Identify risks, potential impacts, and mitigation strategies.  
  • Ability to anticipate issues and formulate remedial actions.
  • Team Leadership/management experience in onsite-offshore Model.  (a plus, not a must-have)
  • HRP a plus
  • Testing Experience - a plus

 

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About NTT DATA Services

NTT DATA Services is a global business and IT services provider specializing in digital, cloud and automation across a comprehensive portfolio of consulting, applications, infrastructure and business process services. We are part of the NTT family of companies, a partner to 85 % of the Fortune 100.

NTT DATA Services is an equal opportunity employer and will consider all qualified applicants for employment without regard to race, gender, disability, age, veteran-status, sexual orientation, gender identity, or any other class protected by law.


Nearest Major Market: Boston

Job Segment: Consulting, Quality Assurance, Cloud, Testing, Project Manager, Technology